[Evaluation of immune response after thymectomy]. / Ocena odpornosci po usunieciu grasicy.

Immunological status of children after thymectomy performed at the age between 2 months and 15 years for teratoma in 5, and hyperplasia in 1. Cellular immunity parameters--as percent and total T lymphocyte count and their PHA reactivity, humoral immunity--as IgG, IgA, IgM concentrations, and phagocytosis--as phagocytosis index, NBT test, complement components--C3c, C4--concentration were evaluated between 6 and 12 years following surgery. No abnormalities within investigated parameters, nor the history of more frequent infections or other immunological disorder were detected.

[Traumatic splenic rupture--personal treatment principles]. / Die traumatische Milzruptur--unsere Behandlungsprinzipien.

The following proceedings presents the results and principles of treatment in infants with a traumatic rupture of the spleen treated in our division. The principle to save the injured organ in any case, enabled us to save the spleen in all of the 9 children.

[Results of the treatment of children with neurogenic bladder by transurethral intravesical electric stimulation]. / Ocena wyników usprawniania dzieci z neurogennym uszkodzeniem pecherza moczowego przez cewkowa Sródpecherzowa elektrostymulacje.

The intravesical transurethal electrostimulation was introduced by F. Katona in order to create consciously controlled micturition in patients with neurogenic bladder lesions. The principle of therapy is based on the activation of the intramural receptors and vegetative pathways from the bladder with special exponential electric impulses. The electric stimulation should evoke the bladder sensation and finally the conscious urge to void might develop. Simultaneously the detrusor tonus should be normalised and evoked contractions become stronger and organised, to be able to empty bladder in stream. During the period from May 1977 to October 1980, 24 children with neurogenic urinary incontinence (aged 2-18 years), were treated in the Surgical Department of the Institute of Mother and Child. Most of them have been operated on for meningomyelocoele , 1--for spinal ependymoma, 1--suffered from extensive haemangioma of pelvic brim and spine, 1 child had no obvious signs of dysraphism. The therapeutic programme consisted of 2 series of 40 stimulations in each serie , applied every day. Each session lasted 90 minutes. The current parameters were: intensity of exponential waves, steadily increasing from 0,4 to 6 m A, frequency 70 Hz, impulse duration 5 msek . Before treatment the clinical, neurological and radiological evaluation were done. The extension of neurologic deficite and state of urinary tract were assessed. Every child had IVP and micturition cystourethrography. Since 1978 the urodynamic investigations were introduced. Cystometry was performed before and after each serie of stimulation. Since 1979 the measuring of urethral pressure profile was included, for more exact evaluation of the type of bladder lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical treatment of epispadias]. / Leczenie chirurgiczne wierzchniactwa.

The anatomy and pathophysiology of epispadic urethra and bladder is presented. The operative procedures used for correction of the genital deformity and coexisting incontinence are described. The controversial points concerning the staging of procedures, the choice of optimal time and technic is discussed, with the results reported in recent series. In the Surgical Clinic of the Institute of Mother and Child 15 children with epispadias were treated during 1969-1979. There were 12 males and 3 females. 13 children had complete peno -pubic epispadias, with prolapse of bladder mucosa in two of them. Thery were totally incontinent. Amongst two boys with partial penile deformity 1 had bladder control. IVP showed no abnormalities, excluding solitary kidney in one boy. Cystography revealed wide bladder neck and short urethra with dilation of its posterior part; transient vesico-ureteral reflux was observed in 2 patients. Two children with prolapsing bladder mucosa were operated on when 6 and 14 months old. The age of remaining 13 children at the time of surgery was: between 3,5 and 6 years in 7, 6-9 years in four, the oldest two were 10 and 12. The Cantwell -Young reconstruction of the urethera was usually performed, with mobilizing of corpora cavernosa. In 5 children it was combined with wedge resection of anterior bladder neck and in 4 with infra-pubic wedge excision of dilated anterior urethera and Mayo plasty of external sphincter. The Young- Dees operation was performed twice, as a secondary procedure for treatment of total incontinence. During follow up the gradual improvement of bladder control was observed. Continence was achieved in 5, including 2 children after Young- Dees plasty. 3 children have stress incontinence, another 3 are dry at night and at rest, but wet during normal activities, 1 is totally incontinent.(ABSTRACT TRUNCATED AT 250 WORDS)

[Sacrococcygeal approach in the treatment of defects of the lower segment of the digestive tract]. / Dostep krzyzowy w leczeniu wad dolnego odcinka przewodu pokarmowego.

The research investigations carried out for years revealed most details on embryology nd pathophysiology of anorectal malformations. They left still unsolved the problem how to obtain better functional results following their surgical treatment. It is well known, that in the group of high- supralevator deformities, the lower rectum, anal canal and internal sphincter are absent, and the terminal pouch lyes above the puborectalis sling. The purpose of the of the pull-through procedure is the reconstruction of proper relationship between bowel, the levator diaphragm and external sphincter, without damage to the muscles and pelvic plexus. The technics advocated by Stephens and Rehbein are apparently important steps forward in surgery of these defects. The sacrococcygeal route of Kraske, adapted by Stephens for operative treatment of anorectal malformations, gives approach from behind to the supralevator space for identification of puborectalis sling. The muscle is separated from urethra or vagina, and gradually the tunnel through the sling and external sphincter is created. The gentle and in proper plane pull of the bowel through an undamaged puborectalis muscle gives the possibility to save its function as rectal sphincter and receptor as well. This paper presents 76 children with anorectal malformations, treated in the Department of Pediatric Surgery during 1966 to 1975 yr. The "International" Classification, proposed in Melbourne was used to group the patients according to the level of the terminal bowel: in Supralevator , Intermediate and Translevator defects (tab. I-III). The surgical procedures in particular types of anomalies are presented in the tables IV-VII. The detailed clinical evaluation and roentgenological examination were the base to assess the type of malformation and to choose the method of treatment. To find other coincidental malformations, generally most frequently occurring in the genitourinary tract, the intravenous pyelography was the routine early investigation. Other tests, like cystography and endoscopy were done when indicted. The genitourinary tract abnormalities were found in 9 of 14 children with supralevator deformities, in 9 of 17 children with intermediate type and in 17 of 45 from the translevator group. Oesophageal atresia was present in 6 children, the congenital heart failure in 13 and skeletal malformations in 21 of the total. In neonates with supralevator anomalies the primary reconstructions were not very successful, so transversostomy became a routine preliminary procedure.(ABSTRACT TRUNCATED AT 400 WORDS)